Washington, D.C., partner Jesse Witten was quoted in Modern Healthcare in an article titled, “Unclear terms: 'Unnecessary' Use of Stents Can be Hard to Prove.”
The article discusses the high-stakes cardiac-care investigations into what constitutes an inappropriate or unnecessary angioplasty as a convicted cardiologist entreats the U.S. Circuit Court of Appeals in Richmond, Va. to overturn his eight-year prison sentence for performing unnecessary heart procedures.
The doctors and hospitals under investigation complain that it's not clear what “unnecessary” means, and that the government is wading into dangerous territory by second-guessing clinical decisions on which reasonable people may have legitimate disagreements.
Lawyers, however, say cases of cardiac overuse are tough to prove in court, because juries are reluctant to convict doctors in cases where medical experts disagree over the initial treating physician's judgment.
Jesse, a member of the firm’s White Collar Criminal Defense & Corporate Investigations team and a former co-chairman of a Justice Department (DOJ) healthcare fraud task force, said the allegations that lead to criminal charges usually involve written evidence that purports to show bad intent.
“If the doctor was creating a false record, it undermines the claim that he truly was exercising medical judgment,” he said. “I think it's so obvious to the DOJ that these are difficult cases to bring that they are not going to file a case unless there is something really egregious that has occurred.”
To read the Modern Healthcare article, click the link below.